Outcomes of ocular evisceration and enucleation in the British Armed Forces from Iraq and Afghanistan

Abstract

Background/Objectives To evaluate outcomes from all British military patients who underwent eye removal during the Iraq and Afghanistan wars. Subjects/Methods Retrospective case note review of all patients (n = 19) who had undergone either evisceration or enucleation, on a database of all military patients repatriated to the Royal Centre for Defence Medicine, Birmingham. Results Twenty eye removals were performed on 19 patients, of which 14 (70%) were eviscerations and 6 (30%) were enucleations. Orbital wall fractures were seen in 12 (61%) patients, with orbital floor fractures being the most common. The eye removal was a primary procedure in five of fourteen eviscerations, and five of six enucleations. Complications were seen after four (28.6%) eviscerations patients and two (33.3%) enucleations. Postoperative pain was problematic after three (21.4%) eviscerations but no enucleations. Orbital implants were placed during three of the five primary enucleations, with good outcomes in two. One patient however required implant retrieval and wound washout due to a high risk of infection and communication with the intra-cranial space. Conclusions Evisceration and enucleation are both viable options in the management of severe ocular trauma in military patients. Evisceration and enucleation have similar complication rates and outcomes, and both have low rates of sympathetic ophthalmia. Primary orbital implants can be at high risk in cases with orbital roof fracture, but can provide good outcomes in select patients.

The Ruptured Globe, Sympathetic Ophthalmia, and the 14-Day Rule

“…172 Gürdal et al 176 added further support to Levine’s conclusion after their review of 183 eviscerations over 10 years, also without a report of a single case of SO. Subsequent reports by du Toit et al 39 of noncombat traumatic cases over 10 years failed to identify a single case of SO in 502 eviscerations as did other smaller reports by Zheng et al, 181 Holmes, 33 and Reed et al 177 The current consensus is that evisceration in the post-trauma eye requiring removal is an acceptable choice of procedure. 33,39,177,181,186 Although it does have a very low potential to be causative for SO, it has not been confirmed as a significantly increased risk for the disease.…”

“…6 The antigen exposure at the time of injury is thought to be limited by timely globe closure, or removal of the uveal tract, that is, enucleation. 33…”

“…40 SO reported in military conflicts has decreased significantly throughout the last century despite an increase in incidents of ocular trauma. 6,33,[41][42][43][44][45] Few well-documented cases of SO occurred during World Wars I and II and none in the Korean, Vietnam, or 6-day wars. 6 Wong et al 42 cite 4 additional 20 th century conflicts in the Middle East where 5.6%-13% of combat injuries involved eye casualties, but there were no reports of SO.…”

Two 11-Years Periods Statistics and Trends of Enucleation and Evisceration

“…In patients with military wounds, the extent of enucleations is the equivalent in extreme wrecking eye wounds, however, the level of thoughtful ophthalmia is low in both surgeries. 19 …”

Ocular TASER Probe Injury Managed with Primary Evisceration: Case Report

“…These statistics reaffirm the thought that the injured eye should be salvaged and repaired with monitoring for SO with routine ophthalmic care. As a result, the practice of prophylactic enucleation to prevent SO in a traumatized eye has progressively fallen out of favor, as suggested by multiple case series discussing enucleation in traumatized eyes from other mechanisms [ 12 , 13 ].…”